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Welten JJE, Cox VCM, van Eijk RPA, van Heugten CM, Visser-Meily JMA, Schepers VPM. The Effects of a Blended Care Intervention in Partners of Patients With Acquired Brain Injury - Results of the CARE4Carer Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:352-358. [PMID: 37690740 DOI: 10.1016/j.apmr.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess effects of the CARE4Carer blended care intervention on caregiver mastery and psychosocial functioning compared with usual care in partners of patients with acquired brain injury (ABI). DESIGN Multicenter randomized controlled trial. SETTING Nine sites for rehabilitation medicine. PARTICIPANTS 120 partners of outpatients with ABI were randomly allocated to blended care (N=59) or usual care (N=61). INTERVENTION The blended care intervention (20 weeks) was aimed at improving caregiving skills and consisted of 9 online sessions, combined with 2 face-to-face consultations with a social worker. MAIN OUTCOME MEASURES Mastery was assessed with the Caregiver Mastery Scale, secondary outcome measures were caregiver strain (Caregiver Strain Index), family functioning (Family Assessment Device), anxiety and depression (Hospital Anxiety and Depression Scale), burden (self-rated), and quality of life (CarerQol). Assessments were performed at baseline, 24, and 40 weeks. RESULTS The adjusted mean difference in caregiver mastery between intervention and control group at week 24 was 1.31 (SD3.48, 95% confidence interval (CI) -0.12 to 2.74, P=.072) and at week 40 was 1.31 (SD3.69, 95% CI -0.26 to 2.88, P=.100). In the per protocol analysis, the adjusted mean difference in caregiver mastery at week 24 was 1.53 (SD3.38, 95% CI 0.10 to 2.96, P=.036) and at week 40 was 1.57 (SD3.63, 95% CI 0.01 to 3.14, P=.049). Regarding secondary outcomes, caregiver strain was lower in the intervention group in the per protocol analysis at week 40. Family functioning was higher in the intervention group in week 24, whereas anxiety was lower at both timepoints. CONCLUSIONS In the subset of participants who were able to complete the intervention, caregiver mastery and psychosocial functioning improved. Future work should focus on improving adherence as this will optimize beneficial effects of blended care.
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Affiliation(s)
- Jennifer J E Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Vincent C M Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Morgenstern LB, Almendarez EM, Mehdipanah R, Kwicklis M, Case E, Smith MA, Lisabeth LD. Methods and early recruitment of the Brain Attack Surveillance in Corpus Christi-Post-acute Care (BASIC-PAC) Project. J Stroke Cerebrovasc Dis 2022; 31:106851. [PMID: 36335753 PMCID: PMC10024336 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke outcomes. We report here the methods, background literature, and initial recruitment of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers, and community. MATERIALS AND METHODS Rigorous active and passive stroke surveillance captures all strokes in Nueces County, Texas. Stroke patients are followed for 90 days to determine their care transitions and factors influencing their rehabilitation setting. Informal caregivers of the stroke patients are identified and interviewed at 90 days to determine aspects of their caregiving and caregiver outcomes. Available community resources are compared with stated needs among stroke patient and caregivers to determine unmet needs. RESULTS Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413 were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by 355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating potential caregivers met the eligibility criteria. CONCLUSIONS BASIC-PAC has strong initial recruitment and is poised to provide valuable data on multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse stroke outcomes in MAs. Based on the study findings, interventions can be developed that will improve stroke health equity.
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Affiliation(s)
- Lewis B Morgenstern
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States.
| | - Elizabeth M Almendarez
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, United States
| | - Madeline Kwicklis
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Erin Case
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Melinda A Smith
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Lynda D Lisabeth
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States
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Care Dependency of Hospitalized Stroke Patients Based on Family Caregivers’ and Nurses’ Assessments: A Comparative Study. Healthcare (Basel) 2022; 10:healthcare10061007. [PMID: 35742058 PMCID: PMC9222839 DOI: 10.3390/healthcare10061007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Stroke impacts care dependency, and thus the patient needs home care after suffering a stroke. This study was carried out to investigate similarities and differences between the assessments made by family caregivers and nurses regarding the care dependency level of stroke patients in Indonesian hospitals. This study was a comparative study of the care dependency of stroke patients. Data were collected on the stroke wards on the day of admission using the Care Dependency Scale (CDS). The sample consisted of 118 family caregivers and 21 nurses. The Wilcoxon signed-rank test was performed to determine the mean differences between the paired data collected by family caregivers and nurses. The results of this study show that significant differences exist between the family caregivers’ and nurses’ assessments regarding the care dependency levels of stroke patients. Nurses assigned higher scores to all CDS items than family caregivers did. Significant differences between the family caregivers’ and nurses’ assessments were observed on numerous items of the Care Dependency Scale. This study contributes to efforts to raise awareness of potential differences in perceived care dependency levels of stroke patients. The findings can help nurses plan the patient’s discharge together with family caregivers.
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Formal Health and Social Services That Directly and Indirectly Benefit Stroke Caregivers: A Scoping Review of Access and Use. Can J Nurs Res 2022; 54:211-233. [PMID: 35130749 PMCID: PMC9109593 DOI: 10.1177/08445621211019261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Stroke can be a life altering event that necessitates considerable amounts of
formal and informal care. The impacts of stroke often persist over time
requiring ongoing support for stroke survivors. Family members provide the
majority of care and experience many life changes as a result of their
caregiving role including social, financial, employment and health impacts.
Formal supports such as counselling, respite, and health promotion initiatives
that directly benefit caregivers or benefit them indirectly through supporting
the stroke survivor, are well-placed to help caregivers manage their caregiving
role. However, to date little is known about formal service use by stroke
caregivers and the factors that influence their service use. This scoping review
provides a critique and synthesis of what is known about stroke caregivers’
access and use of formal services intended to support them. Findings suggest
that while services are available, caregivers’ ability to use them are impacted
by both facilitators and barriers. Facilitators included: sex, age, and having a
higher household income (depending on services used). Barriers included: high
cost, poor service quality and deficient knowledge/communication regarding
service availability. This review highlights a significant gap in our knowledge
of caregivers’ experience in accessing and using formal services.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Abstract
OBJECTIVE Family caregiving research has evolved since its inception in the late 1970s. The objective of this brief report was to summarize the research areas and findings to date with the goal of highlighting directions for future research. DESIGN Narrative review. SETTING Not applicable. PARTICIPANTS Published scientific articles in neurological populations including spinal cord injury, traumatic brain injury, and stroke. INTERVENTIONS Not applicable. OUTCOME MEASURES Not applicable. RESULTS Caregiving research began with a description of the impact of providing care on caregiver health and wellbeing. Intervention research followed to support caregivers in their role and improve caregiving outcomes. Recent reviews conclude a "one size fits all" intervention will not be sufficient to support caregivers. New research suggests caregivers have different patterns of adjustment to the caregiving role highlighting heterogeneity in the caregiving population. Research is also advancing to support patients and families as they transition across care environments by enhancing the timing of intervention delivery. Health care systems do not routinely adopt evidence-based caregiver interventions. As a result, recent research has begun to identify factors that influence the adoption of evidence-based caregiver interventions by health care systems. Ultimately, family centered care that addresses the needs of not only the patient but also the caregiver may be the best way to meet the needs of a heterogeneous group of caregivers across the care continuum. CONCLUSIONS Family caregivers make an important contribution to the health and wellbeing of individuals with spinal and other neurological conditions. Ultimately, system changes, like family centered care, may be best suited to meet the complex needs of this heterogeneous group of caregivers.
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Affiliation(s)
- Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada,Correspondence to: Jill I. Cameron, Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 160–500 University Ave., Office room 922, Toronto, ONM5G 1V7, Canada; Ph: 416-978-2041 (office); 416-523-4689 (cell). ; @Caregiving_UofT
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Gawulayo S, Erasmus CJ, Rhoda AJ. Family functioning and stroke: Family members' perspectives. Afr J Disabil 2021; 10:801. [PMID: 34858798 PMCID: PMC8603059 DOI: 10.4102/ajod.v10i0.801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Stroke survivors often experience permanent or temporal physical and psychological stroke impairments. As a result, stroke survivors are often discharged to recover in their home environments and are cared for mostly by family members. Additionally, caregiving roles are often assumed without any formal training or preparation whatsoever. This can transform the family’s functional patterns due to adjustments that are made to accommodate the caregiving needs. Objectives To explore the experiences and influence of stroke on families and on family functioning. Method Explorative descriptive qualitative research design through the use of in-depth interviews were employed as the means of data collection. The sample size was eight (8) family members and was guided by the saturation point. Data was thematically analysed. Results Four themes emerged from the analysis: 1) reduced interactions with family members due to communication barriers, 2) the influence of stroke on family relationships, 3) emotional engagement in caring for a family member with a stroke and 4) financial implications of stroke on family functioning. This study found that stroke can influence the family functioning negatively as family members may be forced to change their functional patterns. However, some family members reported positive experiences, they developed a supportive structure to accommodate the new life of the stroke survivor. Conclusion Using the McMaster’s model of family functioning, this study found that stroke is a threat to the six dimensions of family functioning: 1) problem-solving, 2) communication, 3) roles, 4) affective responsiveness, 5) affective involvement, and 6) behaviour control.
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Affiliation(s)
- Sibulelo Gawulayo
- Department of Social Work, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Charlene J Erasmus
- Centre for Interdisciplinary Studies on Children, Families and Society, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Anthea J Rhoda
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Anderson MA, Buffo C, Ketcher D, Nguyen H, MacKenzie JJ, Reblin M, Terrill AL. Applying the RISE Model of Resilience in Partners Post-Stroke: A Qualitative Analysis. Ann Behav Med 2021; 56:270-281. [PMID: 34228090 DOI: 10.1093/abm/kaab053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Resilience is dynamic and influenced by internal and external factors. In persons with chronic illness and/or disability, resilience is viewed as the ability to adapt to new life circumstances. Existing models of resilience typically focus on the absence of deficit and pathology in the individual, overlooking resources, well-being, and broader social impacts. Our proposed novel Relational, Intrapersonal, Social and Environmental (RISE) Model of resilience incorporates and describes the interconnection and influence of constructs that impact resilience and affect the quality of life. PURPOSE The purpose of this study is to examine the fit of the RISE Model against original interview data obtained from persons with stroke and their partners. METHODS This study is a secondary analysis of qualitative data collected from post-intervention interviews that were part of an intervention pilot study designed to promote resilience in couples coping with stroke. Interviews were coded to examine relationships between RISE Model constructs. RESULTS The study included 36 interviews from 18 cohabitating couples; mean participant age was 53.33 years (SD ±14.70). Examples of each construct within the RISE Model appeared in transcribed interviews and common patterns of co-occurring constructs were identified. CONCLUSION The constructs within the RISE Model were supported by the interviews. The impact of disability does not remain confined to a single individual and instead branches out into the broader social context, including close interpersonal relationships. A deeper understanding of resilience and its relationship with intrapersonal, interpersonal and socio-ecological constructs would add value to our understanding and fostering of resilience in persons with disabilities and/or chronic illness. CLINICAL TRIAL INFORMATION NCT03335358.
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Affiliation(s)
- Miranda A Anderson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Corinne Buffo
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Dana Ketcher
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hop Nguyen
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
| | - Justin J MacKenzie
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, USA
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Olafsdottir SA, Jonsdottir H, Bjartmarz I, Magnusson C, Caltenco H, Kytö M, Maye L, McGookin D, Arnadottir SA, Hjaltadottir I, Hafsteinsdottir TB. Feasibility of ActivABLES to promote home-based exercise and physical activity of community-dwelling stroke survivors with support from caregivers: A mixed methods study. BMC Health Serv Res 2020; 20:562. [PMID: 32571316 PMCID: PMC7310069 DOI: 10.1186/s12913-020-05432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Technical applications can promote home-based exercise and physical activity of community-dwelling stroke survivors. Caregivers are often able and willing to assist with home-based exercise and physical activity but lack the knowledge and resources to do so. ActivABLES was established to promote home-based exercise and physical activity among community-dwelling stroke survivors, with support from their caregivers. The aim of our study is to investigate the feasibility of ActivABLES in terms of acceptability, demand, implementation and practicality. Methods A convergent design of mixed methods research in which quantitative results were combined with personal experiences of a four-week use of ActivABLES by community-dwelling stroke survivors with support from their caregivers. Data collection before, during and after the four-week period included the Berg Balance Scale (BBS), Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG) and Five Times Sit to Stand Test (5xSST) and data from motion detectors. Semi-structured interviews were conducted with stroke survivors and caregivers after the four-week period. Descriptive statistics were used for quantitative data. Qualitative data was analysed with direct content analysis. Themes were identified related to the domains of feasibility: acceptability, demand, implementation and practicality. Data was integrated by examining any (dis)congruence in the quantitative and qualitative findings. Results Ten stroke survivors aged 55–79 years participated with their informal caregivers. Functional improvements were shown in BBS (+ 2.5), ABC (+ 0.9), TUG (− 4.2) and 5xSST (− 2.7). More physical activity was detected with motion detectors (stand up/sit down + 2, number of steps + 227, standing + 0.3 h, hours sitting/lying − 0.3 h). The qualitative interviews identified themes for each feasibility domain: (i) acceptability: appreciation, functional improvements, self-initiated activities and expressed potential for future stroke survivors; (2) demand: reported use, interest in further use and need for follow-up; (3) implementation: importance of feedback, variety of exercises and progression of exercises and (4) practicality: need for support and technical problems. The quantitative and qualitative findings converged well with each other and supported the feasibility of ActivABLES. Conclusions ActivABLES is feasible and can be a good asset for stroke survivors with slight or moderate disability to use in their homes. Further studies are needed with larger samples.
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Affiliation(s)
- Steinunn A Olafsdottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland.
| | - Helga Jonsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingibjörg Bjartmarz
- Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Mikko Kytö
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland.,Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Laura Maye
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - David McGookin
- Department of Computer Science, Aalto University in Helsinki, Espoo, Finland
| | - Solveig Asa Arnadottir
- Department of Physical Therapy, Faculty of Medicine, School of Health Sciences, University of Iceland, Stapi við Hringbraut, 102, Reykjavik, Iceland
| | - Ingibjörg Hjaltadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Division of Clinical Services I, Landspitali- The National University Hospital of Iceland, Reykjavik, Iceland
| | - Thora B Hafsteinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Cox V, Schepers V, Ketelaar M, van Heugten C, Visser-Meily A. Participation Restrictions and Satisfaction With Participation in Partners of Patients With Stroke. Arch Phys Med Rehabil 2020; 101:464-471. [DOI: 10.1016/j.apmr.2019.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
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10
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Tseung V, Jaglal SB, Salbach NM, Yoshida K, Cameron JI. Key informants' perspectives on implementing caregiver programs in an organized system of stroke care. Disabil Rehabil 2019; 43:1145-1152. [PMID: 31424961 DOI: 10.1080/09638288.2019.1652704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Family caregivers provide essential support to individuals recovering after experiencing a stroke. Although clinical guidelines recommend the provision of caregiver education and support, these guidelines have not been implemented into standard clinical practice. The objective of this study was to gain insight from key informants-affiliates of a regional stroke system-to identify organization and system level barriers and facilitators associated with implementing stroke caregiver programs. METHODS Twelve key informants were interviewed. Informants discussed their experiences with and perceptions of caregiver programs. They also identified barriers and facilitators to implementing caregiver programs. Interview data were analyzed using inductive thematic analysis. RESULTS Three themes were generated: (1) lack of consensus on the need for caregiver education and support programs as part of the health care system; (2) a collaborative process is needed to engage stakeholders and identify champions (3) stakeholders need different types of evidence in support of implementation. CONCLUSIONS This study provides initial insight into the potential barriers and facilitators needed to develop and implement stroke caregiver programs. Further exploration of these topics can inform caregiver program development and their implementation into stroke systems of care.IMPLICATIONS FOR REHABILITATIONRehabilitation research needs to demonstrate that caregivers are a unique group in need of support from the health care system.Rehabilitation research needs to contribute to the evidence that caregiver programs can improve patient, caregiver, and health system outcomes.Researchers can enhance caregiver program implementation through collaboration between researchers, stakeholders, and system change champions starting with program development.
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Affiliation(s)
- Victrine Tseung
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Susan B Jaglal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Karen Yoshida
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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11
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Scholten EWM, Hillebregt CF, Ketelaar M, Visser-Meily JMA, Post MWM. Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review. Disabil Rehabil 2019; 43:746-772. [PMID: 31366259 DOI: 10.1080/09638288.2019.1641847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE (1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies. MATERIALS AND METHODS Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies. RESULTS (1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire. CONCLUSIONS There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection. PROSPERO REGISTRATION CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.
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Affiliation(s)
- Eline W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chantal F Hillebregt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMCU Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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12
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Guo L, Zauszniewski JA, Liu Y, Yv S, Zhu Y. Is resourcefulness as a mediator between perceived stress and depression among old Chinese stroke patients? J Affect Disord 2019; 253:44-50. [PMID: 31029012 DOI: 10.1016/j.jad.2019.04.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/07/2019] [Accepted: 04/21/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to explore whether resourcefulness can serve as a mediator between perceived stress and depression among old Chinese stroke patients. METHODS A cross-sectional study was conducted in six hospitals during July 2016 to July 2017, from five cities of Henan Province, China. A demographic questionnaire, the Perceived Stress Scale (PSS), the Resourcefulness Scale (RS) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed among 3000 old stroke patients, and 2907 of them completed this survey. Correlation analysis, multiple linear regression and structural equation model (SEM) were used for statistical analysis of the study. RESULTS The total scores of the resourcefulness were negatively correlated with perceived stress (r= -0.795, P<0.01) and depression (r= -0.772, P<0.01); It indicated positive correlation of the total scores of perceived stress and depression (r = 0.820, P<0.01). Multiple regression analyses showed that resourcefulness mediated the relationship between perceived stress and depression, which reduced the effect of perceived stress on depression by 16.3% (from 0.464 to 0.301) on the subscale "sense of being out of control" and by 20.3% (from 0.411 to 0.208) on the subscale "feeling of tension" when resourcefulness was included in the model. Structural equation model validated these findings, and further confirmed that resourcefulness had a partial mediation effect (39.4% of total effect) between perceived stress and depression. LIMITATIONS This cross-sectional study does not allow for examination of the relationship between pre-stroke resourcefulness and post-stroke depression, or the potential intervening role of perceived stress. CONCLUSION Resourcefulness was found to be a mediator between perceived stress and depression, suggesting the potential benefit of an intervention to teach resourcefulness skills to decrease depression in highly stressed older Chinese stroke patients.
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Affiliation(s)
- Lina Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University. Euclid Avenue Cleveland, Ohio, USA
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 Henan, People's Republic of China.
| | - Suyuan Yv
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yiru Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Steppacher I, Kissler J. A problem shared is a problem halved? Comparing burdens arising for family caregivers of patients with disorders of consciousness in institutionalized versus at home care. BMC Psychol 2018; 6:58. [PMID: 30547843 PMCID: PMC6295043 DOI: 10.1186/s40359-018-0272-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/28/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Disorders-of-consciousness (DOC) are rare conditions leading to very severe physical and mental disabilities. Providing care for DOC patients has been described as a stressful experience, eroding the physical and psychological health of the caregiver. Different forms of care may have different impacts on the caregivers and institutionalized care has been suggested to have an unburdening effect, but this possibility has never been empirically studied. To address this issue, in this study caregiver-burden between family-caregivers who provide home care themselves and those who have placed their patients in a specialized care unit is compared. METHOD The demographics of the caregivers, life satisfaction, coping strategies, meaning in life, and grief reactions were assessed with questionnaires in 81 long term (m = 7.9 years) caregivers (44 patients in specialized care-units, 37 patients taken care of at home). RESULTS Caregiver groups were similar on the vast majority of demographic factors. Remarkably, there were no major differences in self-assessed burden and distress between the two caregiver groups. They both demonstrated generally reduced life satisfaction, were especially dissatisfied with their amount of spare time, and many caregivers in both groups demonstrated long lasting grief reactions, as well as a somewhat enhanced crisis of meaning. However, caregivers with patients in institutionalized care exhibited enhanced self-accusation as well as reduced satisfaction with their own health. Home care caregivers, on the other hand, report below average opportunities to care for themselves. CONCLUSION Surprisingly, placement in institutionalized care in itself does not seem to disburden caregivers as much as expected as the amount of subjective care-giving burden and reported distress is on average similarly high, although profiles differ somewhat according to type of care. Moreover, vast inter-individual variability can be observed. Further research should address the mechanisms that foster positive adjustment and reduce negative impacts for care providers regardless of type of care, enabling the health care system, institutions and self-aid groups alike, to provide more specific support for caregivers by addressing the topics of quality-of-life, own health, self care, and grief reactions.
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Affiliation(s)
- Inga Steppacher
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Johanna Kissler
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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Vincent-Onabajo G, Puto Gayus P, Masta MA, Ali MU, Gujba FK, Modu A, Hassan SU. Caregiving Appraisal by Family Caregivers of Stroke Survivors in Nigeria. J Caring Sci 2018; 7:183-188. [PMID: 30607358 PMCID: PMC6311622 DOI: 10.15171/jcs.2018.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 10/22/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction: Attending to caregiving experiences of family caregivers of stroke survivors is important in person-centered stroke rehabilitation. This study explored caregiving appraisals by family caregivers of stroke survivors in Nigeria. Methods: A cross-sectional survey of family caregivers' negative and positive appraisals of caregiving was conducted using the 24-item 4-domain revised Caregiving Appraisal Scale (rCAS). Mann Whitney U and Kruskal-Wallis tests were used to identify differences in caregiving appraisals based on specific caregiver and stroke survivor variables. Results: Seventy-three caregiver and care recipient dyads participated in the study. Mean age of the caregivers was 31.51 (9.82) years. From a score of 5, and higher scores depicting higher appraisal, mean (SD) score for caregiving satisfaction and caregiving mastery (positive appraisal domains) was 4.23 (0.97) and 4.04 (0.92) respectively while 2.29 (0.98) and 2.11 (0.93) were respectively recorded for caregiving burden and environmental impact (negative appraisal). Caregivers' gender, age, and employment status resulted in significantly different appraisals with female caregivers having higher caregiving mastery (U = 446, P<0.05), caregiving satisfaction (U = 384.5, P<0.01), and also caregiving burden (U = 382.5, P<0.01) compared to their male counterparts; while older (U = 330; P<0.05) and employed (U = 437.5, P<0.05) family caregivers reported higher caregiving satisfaction and burden respectively than younger and unemployed family caregivers. Conclusion: Given the comparatively higher positive caregiving appraisal, and the documented benefits of positive caregiving appraisal, efforts should be geared towards identifying effective means of reinforcing positive appraisal, and reducing negative stroke caregiving appraisal, especially for female, older and employed family caregivers.
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Affiliation(s)
- Grace Vincent-Onabajo
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Pwadi Puto Gayus
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Mamman Ali Masta
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Muhammad Usman Ali
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Fatima Kachalla Gujba
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Ali Modu
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Saleh Usman Hassan
- Department of Medical Rehabilitation (Physiotherapy), College of Medical
Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
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15
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Vloothuis J, Depla M, Hertogh C, Kwakkel G, van Wegen E. Experiences of patients with stroke and their caregivers with caregiver-mediated exercises during the CARE4STROKE trial. Disabil Rehabil 2018; 42:698-704. [PMID: 30384780 DOI: 10.1080/09638288.2018.1507048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research questions were: (1) how do the patient-caregiver couples exercise together? and (2) what does exercising together bring about, besides more hours of practice?Methods: Semi-structured interviews were conducted with patients and caregivers who participated in the CARE4STROKE intervention. Inductive thematic data analysis was applied.Results: Seven patients and seven caregivers were interviewed. Three different role-dynamics were found during caregiver-mediated exercises: (1) patient in control, (2) in concert, and (3) the caregiver as informal carer. In addition, three themes were identified about what exercising together brings about: (a) tailor-made exercises through active involvement, (b) preparation for the home situation, and (c) opportunity to be involved.Conclusion: Different role-dynamics are at play in caregiver-mediated exercises, and it is important for participating staff to be aware of their possible effects on the strain of patient or caregiver. Caregiver-mediated exercises were found to enhance individualization of the treatment plan and preparation for home discharge.Implications for rehabilitationCaregiver-mediated exercises, in which a caregiver does exercises with a patient, are currently under investigation as a new form of augmented exercise delivery after strokeDoing exercises together seems to make patient and caregivers actively involved in rehabilitation, which they appreciate, and which seems to help them prepare for the home situationCaregiver selection and monitoring role-dynamics during exercising is an important task of the rehabilitation team.
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Affiliation(s)
- Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja Depla
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Evanston, IL, USA
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
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16
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Guo LN, Liu YJ, McCallum J, Söderhamn U, Ding XF, Yv SY, Zhu YR, Guo YR. Perceived stress and depression amongst older stroke patients: Sense of coherence as a mediator? Arch Gerontol Geriatr 2018; 79:164-170. [PMID: 30265911 DOI: 10.1016/j.archger.2018.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to explore the relationship between perceived stress, sense of coherence, and depression among older stroke patients. METHODS A demographic questionnaire, the Perceived Stress Scale (PSS), the Sense of Coherence Scale (SOC) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed to 3000 older stroke patients from Neurology wards in six large general hospitals, and 2907 individuals completed the survey. Data analysis consisted of correlation, multiple linear regression, and structural equation modeling. RESULTS The total score of the SOC and perceived stress showed a negative correlation (r = -0.80, P < 0.01), the total SOC of coherence and depression also resulted in a negative correlation (r = -0.77, P < 0.01), and the total score of the perceived stress and depression resulted in a positive correlation (r = 0.82, P < 0.01). The results of multiple regression analyses indicated that SOC mediated the association between perceived stress and depression, and the influence of perceived stress on depression was decreased by 16.0%with in the sense of being out of control dimension and was decreased by 12.3% within the feeling of tension dimension when sense of coherence was added to the model. The structural equation model confirmed that the sense of coherence had a partial mediation effect between perceived stress and depression. CONCLUSION SOC is the mediating variable between perceived stress and depression, and can reduce the influence of perceived stress on depression.
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Affiliation(s)
- Li-Na Guo
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yan-Jin Liu
- Department of Nursing, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Jacqueline McCallum
- Department of Nursing & Community Health, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Ulrika Söderhamn
- Faculty of Health and Sport Sciences, Department of Health and Nursing Sciences, University of Agder, Grimstad, Aust-Agder, Norway.
| | - Xian-Fei Ding
- Department of Integrated ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Su-Yuan Yv
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yi-Ru Zhu
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yv-Ru Guo
- Department of Osteology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
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17
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Jellema S, Wijnen MAM, Steultjens EMJ, Nijhuis-van der Sanden MWG, van der Sande R. Valued activities and informal caregiving in stroke: a scoping review. Disabil Rehabil 2018; 41:2223-2234. [DOI: 10.1080/09638288.2018.1460625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sandra Jellema
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Mandy A. M. Wijnen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther M. J. Steultjens
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Scientific Institute for Quality of Healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob van der Sande
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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18
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Ultimate (evolutionary) explanations for the attraction and benefits of chronic illness support groups: Attachment, belonging, and collective identity. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9841-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Malhotra R, Chei CL, Menon EB, Chow WL, Quah S, Chan A, Ajay S, Matchar DB. Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability. Top Stroke Rehabil 2018; 25:261-268. [DOI: 10.1080/10749357.2018.1455369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | | | - Wai-Leng Chow
- Health Services Research, Eastern Health Alliance, Singapore, Singapore
| | - Stella Quah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Shweta Ajay
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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20
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Jones J, Haverhals LM, Manheim CE, Levy C. Fostering Excellence: An Examination of High-Enrollment VHA Medical Foster Home Programs. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017; 30. [PMID: 31660039 DOI: 10.1177/1084822317736795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study aimed to assist the US Veterans Health Administration (VHA) to efficiently target recruitment into VHA Medical Foster Homes (MFHs) by understanding how high-enrollment MFH (HE-MFH) program attributes optimized MFH enrollment. We used an emergent exploratory design to study 3 HE-MFH programs across the United States. Data were collected from August 2013 through June 2014 through individual in-person and phone interviews and in-person focus group discussions with 39 MFH care providers. Three main themes emerged as essential for optimizing HE-MFH program enrollment: (1) alignment of right caregiver, right home, and right Veteran; (2) care practices that support caregiver, Veteran, and home-based primary care (HBPC); and (3) workplace practices and processes that demonstrate support of the MFH coordinator role by facility leadership and the HBPC team.
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Affiliation(s)
| | | | | | - Cari Levy
- University of Colorado, Aurora, USA.,Seattle-Denver Center of Innovation, CO, USA
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21
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Steber AW, Skubik-Peplaski C, Causey-Upton R, Custer M. The Impact of Caring for Persons with Stroke on the Leisure Occupations of Female Caregivers. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2017.1350778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ann Wigginton Steber
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Camille Skubik-Peplaski
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Renee Causey-Upton
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
| | - Melba Custer
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky, USA
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22
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Cox VC, Schepers VP, Ketelaar M, Kruithof WJ, van Heugten CM, Visser-Meily JM. A validation study of the Caregiver Mastery Scale for partners of patients with acquired brain injury. Clin Rehabil 2017; 32:493-500. [PMID: 28956478 DOI: 10.1177/0269215517732821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To validate the Caregiver Mastery Scale for partners of patients with acquired brain injury. DESIGN The score distributions, internal consistency and convergent validity of the Caregiver Mastery Scale were determined. SUBJECTS A total of 92 partners (53% male, age 62 years) of patients with acquired brain injury (91% stroke) discharged from inpatient rehabilitation (time since injury 32 months). MAIN MEASURES Outcome measure: Caregiver Mastery Scale. Reference measures: Caregiver Strain Index, Hospital Anxiety and Depression Scale and CarerQoL. RESULTS The Caregiver Mastery Scale has a normal distribution, with no floor or ceiling effects. Its internal consistency is acceptable (Cronbach's alpha: 0.75). The convergent validity analyses confirmed our hypothesis that higher scores on the Caregiver Mastery Scale correlate with less burden, lower levels of anxiety and depression and greater well-being. Furthermore, partners scoring high on the Caregiver Mastery Scale mostly scored below the clinical cut-off scores on the Caregiver Strain Index and the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, whereas partners scoring low on the Caregiver Mastery Scale were more likely to score above the cut-off points. CONCLUSION The Caregiver Mastery Scale is a valid instrument to assess the caregiver mastery of partners of patients with acquired brain injury.
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Affiliation(s)
- Vincent Cm Cox
- 1 Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,2 De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera Pm Schepers
- 1 Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,2 De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,3 Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- 1 Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,2 De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Willeke J Kruithof
- 1 Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,2 De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,3 Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline M van Heugten
- 4 Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,5 School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johanna Ma Visser-Meily
- 1 Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,2 De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,3 Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Grigorovich A, Lee A, Ross H, Woodend AK, Forde S, Cameron JI. A longitudinal view of factors that influence the emotional well-being of family caregivers to individuals with heart failure. Aging Ment Health 2017; 21:844-850. [PMID: 27077788 DOI: 10.1080/13607863.2016.1168361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Caring for community-residing patients with heart failure can affect caregivers' emotional wellbeing. However, few studies have examined caregivers' well-being longitudinally, or identified factors associated with positive and negative outcomes. The objective of this longitudinal cohort study was to examine changes in caregivers' well-being over time, and to identify patient and caregiver factors associated with positive and negative outcomes. METHOD Fifty caregiver/heart failure patient dyads were recruited from an acute care facility and followed in the community. All participants completed surveys at hospital admission and 3, 6 and 12 months later. Caregivers completed assessments of depression symptoms and positive affect and standardized measures to capture assistance provided, mastery, personal gain, social support, participation restriction, and patients' behavioral and psychological symptoms. From patients, we collected demographic characteristics and health-related quality of life. Individual Growth Curve modelling was used to analyze the data. RESULTS Caregivers' negative and positive emotions remained stable over time. Depression symptoms were associated with higher participation restriction in caregivers. Positive affect was associated with more personal gain and more social support. Patients' health-related quality of life and their behavioral and psychological symptoms were not significantly associated with caregivers' emotional outcomes. CONCLUSION Interventions should be offered based on caregivers' needs rather than patients' health outcomes, and should focus on fostering caregivers' feelings of personal gain, assisting them with securing social support, and engaging in valued activities.
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Affiliation(s)
- Alisa Grigorovich
- a Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada
| | - Adrienne Lee
- b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Heather Ross
- c Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network , Toronto , ON , Canada
| | - A Kirsten Woodend
- d Trent-Fleming School of Nursing, Trent University , Peterborough , ON , Canada
| | - Samantha Forde
- b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada
| | - Jill I Cameron
- a Toronto Rehabilitation Institute, University Health Network , Toronto , ON , Canada.,b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , ON , Canada.,e Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
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24
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Meaning in stroke family caregiving: A literature review. Geriatr Nurs 2017; 38:48-56. [DOI: 10.1016/j.gerinurse.2016.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/10/2016] [Accepted: 07/18/2016] [Indexed: 01/31/2023]
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25
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Grigorovich A, Forde S, Levinson D, Bastawrous M, Cheung AM, Cameron JI. Restricted Participation in Stroke Caregivers: Who Is at Risk? Arch Phys Med Rehabil 2015; 96:1284-90. [DOI: 10.1016/j.apmr.2015.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/20/2015] [Accepted: 03/10/2015] [Indexed: 11/26/2022]
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26
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McKellar J, Cheung D, Huijbregts M, Cameron J. The impact of a community re-engagement cue to action trigger tool on re-engaging in activities post-stroke: a mixed-methods study. Top Stroke Rehabil 2015; 22:134-43. [PMID: 25936545 DOI: 10.1179/1074935714z.0000000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES This study evaluated the guided use of the Community Re-engagement Cue to Action Trigger Tool (CRCATT), a patient-mediated question prompt list, and its impact on self-reported re-engagement in activities post-stroke. METHODS A multi-site, single-blind randomized controlled study in which 77 persons with stroke participated from three rehab organizations in Toronto, Canada. Of the 77 participants, a total 57 within the two groups completed the study and Reintegration to Normal Living Index (mailed response questionnaire) and a sub-set of all participants participated in qualitative interviews. Data collection occurred 3-4 months after enrollment. Quantitative responses were analyzed in SPSS (Chicago, IL, USA) for descriptive frequencies and differences between groups. Qualitative responses were analyzed using an inductive approach with thematic analytic procedures. RESULTS No between group differences were observed due to small sample size. A multi-variable regression model including age, gender, level of education, treatment group, and language, suggests those with higher education are more likely to participate in activities. Interview analysis revealed participants' ability to recover and re-engage is influenced by an interplay of the CRCATT with external factors. These factors include social support, interactions with providers, and ability to access information. CONCLUSION The CRCATT was perceived as a useful tool as it assisted persons with stroke to take a more self-directed role in their care by asking relevant questions and anticipating their needs. The tool complemented the external factors that persons with stroke draw on to support recovery and participate in activities post-stroke.
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27
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Haley WE, Roth DL, Hovater M, Clay OJ. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology 2015; 84:1323-9. [PMID: 25740862 DOI: 10.1212/wnl.0000000000001418] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Three-year changes in well-being were studied among family caregivers of an epidemiologically derived sample of stroke survivors from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and compared to matched noncaregivers. METHODS Family caregivers of REGARDS participants who experienced a stroke event completed telephone interviews assessing depressive symptoms, mental and physical health quality of life (QOL), life satisfaction, and leisure satisfaction at approximately 9, 18, 27, and 36 months after the stroke (n = 235). For each stroke caregiver, a family member of a stroke-free REGARDS participant was enrolled as a matched noncaregiving control (n = 235) and completed similar interviews. RESULTS Multilevel longitudinal models found that caregivers showed poorer well-being at 9 months poststroke than controls on all measures except physical health QOL. Significant differences were sustained for 22 months after the stroke event for depressive symptoms, 31 months for mental health QOL, and 15 months for life satisfaction. For leisure satisfaction, differences were still significant at 36 months poststroke. Caregiving effects were similar across race and sex. CONCLUSIONS Stroke caregiving is associated with persistent psychological distress, but life satisfaction, depression, and mental health QOL became comparable to noncaregivers by 3 years after stroke. Caregiver leisure satisfaction was chronically lower than in noncaregivers. Intervention for stroke caregivers should recognize both the strains faced by caregivers and their capacity for successful coping over time.
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Affiliation(s)
- William E Haley
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham.
| | - David L Roth
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Martha Hovater
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Olivio J Clay
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
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Cameron JI, Naglie G, Green TL, Gignac MAM, Bayley M, Huijbregts M, Silver FL, Czerwonka A. A feasibility and pilot randomized controlled trial of the “Timing it Right Stroke Family Support Program”. Clin Rehabil 2014; 29:1129-40. [PMID: 25552525 DOI: 10.1177/0269215514564897] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/29/2014] [Indexed: 11/16/2022]
Abstract
Objective: Examine feasibility of conducting a randomized controlled trial of the Timing it Right Stroke Family Support Program (TIRSFSP) and collect pilot data. Design: Multi-site mixed method randomized controlled trial. Setting: Acute and community care in three Canadian cities. Subjects: Caregivers were family members or friends providing care to individuals who experienced their first stroke. Intervention: The TIRSFSP offered in two formats, self-directed by the caregiver or stroke support person-directed over time, were compared to standard care. Main measures: Caregivers completed baseline and follow-up measures 1, 3 and 6 months post-stroke including Centre for Epidemiological Studies Depression, Positive Affect, Social Support, and Mastery Scales. We completed in-depth qualitative interviews with caregivers and maintained intervention records describing support provided to each caregiver. Results: Thirty-one caregivers received standard care ( n=10), self-directed ( n=10), or stroke support person-directed ( n=11) interventions. We retained 77% of the sample through 6-months. Key areas of support derived from intervention records ( n=11) related to caregiver wellbeing, caregiving strategies, patient wellbeing, community re-integration, and service delivery. Compared to standard care, caregivers receiving the stroke support person-directed intervention reported improvements in perceived support (estimate 3.1, P=.04) and mastery (estimate .35, P=.06). Qualitative caregiver interviews ( n=19) reflected the complex interaction between caregiver needs, preferences and available options when reporting on level of satisfaction. Conclusions: Preliminary findings suggest the research design is feasible, caregivers’ needs are complex, and the support intervention may enhance caregivers’ perceived support and mastery. The intervention will be tested further in a large scale trial.
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Affiliation(s)
- Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
- Department of Medicine, UHN-Toronto Rehabilitation Institute, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Theresa L Green
- Faculty of Nursing, University of Calgary, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Monique AM Gignac
- Institute for Work and Health; Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Mark Bayley
- Department of Medicine, UHN-Toronto Rehabilitation Institute, Canada
| | - Maria Huijbregts
- Family Service Toronto, Department of Physical Therapy, University of Toronto, Canada
| | - Frank L Silver
- Department of Neurology, UHN-Toronto Western Hospital, Canada
| | - Anna Czerwonka
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
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29
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Bastawrous M, Gignac MA, Kapral MK, Cameron JI. Adult daughters providing post-stroke care to a parent: a qualitative study of the impact that role overload has on lifestyle, participation and family relationships. Clin Rehabil 2014; 29:592-600. [PMID: 25258424 DOI: 10.1177/0269215514552035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/27/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To qualitatively explore daughters' experiences with and response to holding multiple roles while providing post-stroke care to a parent. DESIGN Qualitative study using a descriptive approach. Semi-structured interviewing was used. Interviews were recorded, transcribed and analyzed to develop themes. SETTING General community of a metropolitan city. PARTICIPANTS Twenty-three adult daughters caring for a community-dwelling parent who had suffered a stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS Role overload is a salient issue for daughter caregivers. This overload is best captured by the analogy of "juggling" multiple role demands and responsibilities. Two key themes suggest that role overload resulting from parent care affects daughters': 1) valued relationships (e.g. challenges develop in their relationship with children and partner); and 2) ability to participate in valued activities (e.g. reduced involvement in leisure activities and restricted employment). CONCLUSIONS Future support efforts should help daughters manage the caregiving role in light of other responsibilities. This can mitigate overload-related strain in valued relationships and decreased participation in valued activities, thereby contributing to better health and well-being for daughter caregivers.
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Affiliation(s)
- Marina Bastawrous
- Graduate Department of Rehabilitation Sciences, University of Toronto, Canada
| | - Monique A Gignac
- Division of Health Care & Outcomes Research, Toronto Western Research Institute, Canada
| | - Moira K Kapral
- Division of General Internal Medicine and Clinical Epidemiology, Toronto General Research Institute, Canada
| | - Jill I Cameron
- Graduate Department of Rehabilitation Sciences, University of Toronto, Canada Department of Occupational Science & Occupational Therapy, University of Toronto, Canada
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30
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Jaracz K, Grabowska-Fudala B, Górna K, Kozubski W. Consequences of stroke in the light of objective and subjective indices: A review of recent literature. Neurol Neurochir Pol 2014; 48:280-6. [DOI: 10.1016/j.pjnns.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Affiliation(s)
- Joan S Grant
- From the School of Nursing, University of Alabama at Birmingham (J.S.G., L.S.); and School of Nursing, Auburn University, AL (C.W.H.).
| | - Caralise W Hunt
- From the School of Nursing, University of Alabama at Birmingham (J.S.G., L.S.); and School of Nursing, Auburn University, AL (C.W.H.)
| | - Laura Steadman
- From the School of Nursing, University of Alabama at Birmingham (J.S.G., L.S.); and School of Nursing, Auburn University, AL (C.W.H.)
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32
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Hillis AE, Tippett DC. Stroke Recovery: Surprising Influences and Residual Consequences. Adv Med 2014; 2014:378263. [PMID: 25844378 PMCID: PMC4383285 DOI: 10.1155/2014/378263] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 11/18/2022] Open
Abstract
There is startling individual variability in the degree to which people recover from stroke, and the duration of time over which recovery of some symptoms occur. There are a variety of mechanisms of recovery from stroke, which take place at distinct time points after stroke and are influenced by different variables. We review recent studies from our laboratory that unveil some surprising findings, such as the role of education in chronic recovery. We also report data showing that the consequences that most plague survivors of stroke and their caregivers are not dependence in activities of daily living, but loss of more high level functions, such as empathy or written language. These results have implications for rehabilitation and management of stroke.
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Affiliation(s)
- Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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